I get a fax from a pharmacy, for a refill of a controlled substance.
The patient got 60 days and it's only been thirty. I fax back a refusal.
Next day, call from the patient. I ask how much he is using. He says he got 30 and is using one a day. I will call the pharmacy.
I call the pharmacy. The prescription was from me, but it was an August prescription. The refill would have been in September, the second 30. I ask the pharmacist to check the controlled substances state registry: no record that he filled the prescription in September.
I call the patient and say, find that prescription, because I don't fax those. He got two paper prescriptions, each with a fill starting date and an end date. That is so that I can track if people are using more than prescribed.
Then I think, wait, he's Veteran's Choice. I pull his paper chart. There are the August prescriptions that I faxed to the VA Pharmacy. And actually this patient has called me twice this month. Once because only one of his two prescriptions arrived in the mail and the package had been tampered with. The second time to tell me that the VA pharmacy did not have me entered into their system so would not fill the medicines. Which outrages both of us since it was the VA that called and asked me to see this patient. If they are authorizing me to see a patient, shouldn't they enter me into their system?
So I faxed both prescriptions in August but he only got one, in a tampered package. I call him again. He told the VA the package was tampered, now I call him and ask him to ask the VA if they mailed both medicines. He sighs. "I will call tomorrow. Meanwhile, the medicine?" I fax the medicine to his regular pharmacy and call the pharmacist, because the date is a month ago.
"If the VA already filled it, his insurance won't cover it." says the pharmacist.
"If the VA mailed it, he needs to file a police report that it was stolen," I say. So the pharmacist agrees to call me if the insurance squawks, though if the VA filled it, I would think that it should have been on the WA controlled substances report and it wasn't....
...and at last I go home, feeling rather defeated and down because I still have PILES of paperwork to go through and if every issue takes an hour on the phone.....
...can I keep doing this?
Postscript: I called the VA Pharmacy the next day and they COULD NOT TELL ME whether the controlled substance had been mailed to the patient or not. They did not know and did not care and would not check further or call me back. Serving veterans, right.
And it was not the VA who asked me to see this patient: it was Triwest, the insurance contractor. Who refused to pay me for an entire year. And I am sure that Triwest really is delighted that I was not "entered into the VA system" because then they don't have to shell out for the patient's prescribed medicine.....
triwest: https://www.triwest.com/en/veteran-services/
My local Veterans Affairs: http://www.pugetsound.va.gov/
US Department of Veterans Affairs: https://www.va.gov/